GP Tutorial 3 - Learning Disability

Question 1

What should be discussed in a medication review?

Answer 1

Sometimes people aren’t always able to take all of their medications as it can be difficult. I just need to know what you are taking to form a plan, is that ok?
* Medication on
* When taking?
* How much taking?
* Difficulties?
* Any side effects?

Question 2

How to do a health action plan?

Answer 2

• Formulate patient problem list and formulate action for each one and who should manage it
• Can fill it out on table
• Biopsychosocial approach

Question 3

Strategies to help consultation with someone who has learning disabilities

Answer 3

• Appointment adjustements - longer slot, morning or afternoon to suit them
• Having carer/family present may help communication
• Specialist nurses may be helpful
• Slowing pace of appointment - smaller chunks info, speak to patient
• Give opportunity for patient to ask questions
• Consider seeing alone if ?safeguarding concern

Question 4

Areas to consider in holistic assessment of someone with learning disabilities

Answer 4

• Medical - conditions, understanding, meds review
• Social - ADLs, safeguarding, who supports? work? diet?
• Psychological - coping? support? anxiety/depression
• Caregiver - is mother able to provide level of care she needs? Are they well educated in conditions Debbie has

Question 5

Assessing safeguarding concerns

Answer 5

• Physical exam
• Assess behaviour - withdrawn? fearful?
• Check previous notes - any previous concerns or inconsistencies, not attended appts
• Ask about home life
• Assess carers behaviour and observe dynamics
• Speak 1 to 1 with patient

Question 6

Decision maker for people with LDs - options

Answer 6

• Patient - if they have capacity
• Lasting power of attorner or deputy appointed by court of protection
• Best interests decision
• Independent mental capacity advocates can help patients make decisions if no friends/family available

Question 7

5 principles of MCA 2005

Answer 7

1. Everyone has right to make their own decisions and has capacity unless proven otherwise
2. All practical help must be given before someone is treated to not have capacity
3. People have the right to make unwise decisions or eccentric
4. Anything done on behalf of someone who lacks capacity must be done in their best interests
5. Decisions shouldn’t restrict the freedom of someone lacking mental capacity more than necessary

Question 8

How do we assess capacity?

Answer 8

2 part test
1. Diagnostic test - is there an impairment or disturbance in the functioning of Debbies mind/brain - eg LD, MH disorder, substance misuse, brain injury)
2. Functional - does this impairment mean they cannot understand, retain, weigh up, and communicate their decision

Question 9

Types of abuse and signs

Answer 9

• Psychological - enforced social isolation, preventing choice/opinion
• Neglect - not being brought to appts or missing medications, unkempt
• Physical - bruises/injuries, malnutrition signs
• Sexual abuse - bruises on thighs/buttocks/arms/neck, STI/genital infections, reluctance to be with one person
• Financial - missing possessions, family show unusual interest in assets
• Discriminatory - against protected characteristic
• Modern slavery

Question 10

What options to ensure someone is safeguarded?

Answer 10

• Safeguarding lead at GP practice appointed
• Safeguarding adults boards - report concerns to them, co-ordinate responses in the area
• Involve independent advocates
• Legal aspects - advise about ?deputy via court of protection, report to police if immediate harm
• Voluntary organisations - Mencap, Citizens advice
• Ensure access to community services
• Technology based - personal alarms, monitored bank accounts
• Regular healthough checks - if they don’t attend - f/u with call or home visit
• Educate patients on signs of abuse and what to look out for

Question 11

6 principles of safeguarding

Answer 11

• Empowerment
• Prevention
• Proportionality - respond in least intrusive way
• Protection
• Partnership - work with organisations
• Accountability - everyone involved with that person is responsible

Question 12

What is ‘High value care’?

Answer 12

• Healthcare that balances clinical benefits with costs and potential harm
• Provide the most benefit to patients relative to their costs
• Eliminates unnecessary treatments and ensures good outcomes

Question 13

How do we decide what is funded on NHS?

Answer 13

• Evidence based criteria
• Local funding bodies (eg NHS wheelchair services) - have certain criteria
• Clinical assessments - determine severity and benefit of interventions
• Alternate options have been considered

Question 14

Who decides what is funded on NHS?

Answer 14

• NHS clinical comissioning groups - allocate resources based on local need and priorities
• MDTs assess individual cases
• Input from carers and advocacy groups

Question 15

Ethical concepts that guide decisions around funding

Answer 15

• Justice - fairly distribute
• Utility - maximise benefits with resources
• Equity - resources allocated to underserved/areas that need it most
• Accountability for reasonableness - ensure that decisions are clear, relevent, revisable and enforcable
• Prioritarianism - greater priority given to those worse off/in greater need
• Proportionality - proportionate to need
• Sustainability.- consider long term impacts to ensure system remains effective and accessible for future

Question 16

Responding to conflicts with funding

Answer 16

• Acknowledge
• Discuss resource allocation
• Explain funding decisions - not made by me specifically
• Explore alternatives
• Offer to reassess eligibility if things change